Dental Insurance Articles

What To Do About A Dental Insurance Claim Dispute

2010-09-08

Disputing a dental claim is a sometimes unavoidable and a part of having a dental insurance plan. But there are a number of steps you can take to ensure the process is as painless as possible.

If you find yourself in a situation where a claim dispute is unavoidable, there are a number of steps you need to take. First, be sure you have copies of all records of treatment and visits, as well as copies of all of the bills involved in the dispute. Read over the bills so you are prepared should your dentist or insurance company ask you any questions. Contact your dentist either via phone or letter and explain the issue and the resolution you're looking for. Include copies of the documents you've collected concerning the claim, and explicitly point out any issues. Many times, a potential claim is merely a misunderstanding that a call/letter can resolve.

If you don't feel comfortable contacting your dentist directly or if the dentist does not resolve the situation to your satisfaction, it may be time to contact your insurance company directly. Contact a customer service representative or a representative of the member services department. If they are unable to help you, ask for information about the insurance company's appeal plan and be prepared to file what is called a "first step" grievance. Most insurance companies have a tiered system of dealing with complaints. Each step in the process requires certain actions and documentation.

If all else fails, legal action may unfortunately be necessary. There are also some advocacy groups and state organizations that can help mediate the dispute process.

The easiest way to avoid the inconvenience of having to dispute a dental claim obviously is to avoid a dispute in the first place. Read your policy and understand what is covered and not covered under your dental insurance plan. When discussing treatment plans with your dentist, be sure you understand how far your dental insurance plan will go to reimburse you and what you might have to pay for out of pocket. Ask questions and explain the limitations of your insurance plan to your provider. Taking these simple steps can help you avoid the hassle of having to dispute a claim later.

Educating yourself about your insurance plan is vital to avoiding the hassle of having to dispute a claim. If you do need to dispute a claim, understanding your rights as a patient and the steps your insurance company requires you to take can ensure the process is as painless as possible.